TRAVEL HEALTH PROGRAM <
JULY 2018 NEWSLETTER
Level 3 CDC Warning:
 Avoid Non-Essential Travel to Venezuela
There has been a breakdown of the medical infrastructure in Venezuela. There are shortages of food, water, electricity, medicine, and medical supplies that have contributed to an increasing humanitarian crisis affecting much of the country. Adequate health care is not available through the public health system. For this reason, in addition to crime and civil unrest, the US government has limited ability to provide emergency services to US citizens. Infectious diseases are on the rise, and several large outbreaks are occurring including measles, diphtheria and malaria. CDC recommends that travelers avoid all non-essential travel to Venezuela. Travelers that must go to Venezuela should protect themselves by following CDC’s recommendations. For more information, visit the Department of State Travel Advisory for Venezuala.

 
Map - Venezuela

Outbreaks & Security Concerns

Africa
  • An outbreak of Ebola is occurring in Bikoko area, Equateur province in the northwest corner of The Democratic Republic of the Congo (DRC). Cases have also been found in nearby Iboko and the large city of Mbandaka. A comprehensive public health response has been launched to control the spread of this outbreak. The risk to most travelers to the DRC is low. Travelers could be infected if they come into contact with an infected person’s blood or body fluids. Health care workers caring for patients with Ebola and family and friends caring for an infected person are at highest risk. There is no approved or widely available vaccine, or specific treatment for Ebola, and many people who get the disease die. Travelers should follow CDC recommendations to prevent Ebola.
  • There is a severe water shortage in Cape Town, South Africa. Dam levels are extremely low. The city has implemented water restrictions of 50 liters of water per person per day (a little over 13 gallons). Travelers should reduce shower times to 90 seconds, avoid flushing toilets unless necessary, carry alcohol-based hand sanitizer for hand hygiene and should familiarize themselves with the most up to date water restrictions and recommendations for reducing water use.
  • Health officials in South Africa have reported cases of malaria in Gauteng Province, where Johannesburg and Pretoria are located and in the Waterberg district municipality of Limpopo Province. These are areas where malaria is not typically found. Because malaria is spread by mosquito bites, travelers to Gauteng Province and Waterberg, including resort areas, should take medication to prevent malaria. Travelers should also take precautions to prevent mosquito bites.
  • Public health officials in South Africa have reported an ongoing, severe outbreak of listeriosis that began in early 2017. Most cases have been reported in Gauteng, Western Cape, and KwaZulu-Natal provinces. Over 180 people have died. The source of the listeriosis outbreak has been identified in a variety of processed, ready-to-eat meat products, including “polony”. Listeriosis primarily affects pregnant women and their newborns, older adults, and people with weakened immune systems. Travelers to South Africa should avoid all ready-to-eat processed meat products to reduce their risk of listeriosis.
  • Health officials have reported several cases of measles in the Democratic Republic of the Congo. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • The Nigeria Centre for Disease Control has reported an ongoing outbreak of yellow fever that began in September 2017. Laboratory-confirmed yellow fever cases have been reported in at least seven states, and multiple people have died. CDC recommends anyone 9 months or older who travels to any part of Nigeria should be vaccinated against yellow fever. In addition, Nigerian authorities require proof of yellow fever vaccination from all people one year of age or older who are traveling to Nigeria and are arriving from a country with risk of yellow fever virus transmission. Because of current limitations in the availability of yellow fever vaccine in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel.
  • Cases of polio have been reported in Nigeria and the Democratic Republic of the Congo. The CDC recommends that all travelers to these countries be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Africa with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Asia
  • Health officials in Pakistan have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid that does not respond to most antibiotics. All travelers to Pakistan are at risk of acquiring typhoid fever, but those visiting friends and relatives are at highest risk.Travelers should receive the typhoid vaccine before departure to Pakistan and should take extra care to follow food and water guidelines as recommended by the CDC.
  • Health officials have reported an outbreak of measles in the Philippines and Indonesia. Travelers to these countries should make sure they are vaccinated against measles with the MMR (measles, mumps, and rubella) vaccine and should avoid people that are sick.
  • The Malaysian state of Sarawak has declared parts of three divisions to be rabies infectious areas. Five human rabies cases and almost 800 cases of people being bitten by rabid animals have been reported in Serian, Sri Aman, and Kutching divisions as of July 2017. All people infected with rabies have died. Travelers who anticipate contact with animals such as dogs, cats, bats, or other carnivores should consider rabies vaccination before travel. Even if the pre-exposure rabies vaccine has been received, travelers should still get immediate medical treatment if bitten or scratched by an animal during travel.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Asia with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Caribbean, Central and South America
  • See above Level 3 Warning for details regarding the health infrastructure breakdown in Venezuela. CDC recommends travelers avoid all non-essential travel to Venezuela.
  • There is a large, ongoing outbreak of yellow fever in multiples states of Brazil. Since early 2018, several unvaccinated travelers to Brazil have contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janeiro State). It is now recommended that travelers receive the yellow fever vaccine if visiting or living in all of Espirito Santo State, all of Rio de Janeiro State, including the city of Rio de Janeiro, all of São Paulo State, including the entire city of São Paulo, and a number of cities in Bahia State. Because of a yellow fever vaccine shortage in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel. People who have never been vaccinated against yellow fever should avoid traveling to areas of Brazil where yellow fever vaccination is recommended.
  • Public health officials in Brazil have reported an outbreak of locally transmitted malaria in the town of Wenceslau Guimarães in Bahia State. At this time, CDC recommends that all travelers to Wenceslau Guimarães take medication to prevent malaria. Travelers should also take precautions to avoid mosquito bites.
  • Check the World Map of Areas with Risk of Zika to find out about countries in the Caribbean, Central and South America with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Europe
  • Officials have reported an outbreak of measles in Italy, Ukraine, Greece, England, FranceRomania and SerbiaCDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • Three cases of Plasmodium vivax malaria have been reported in UK residents who traveled to Esentepe (also known as Agios Amvrosios) in the Kyrenia District in Northern Cyprus. CDC recommends that travelers to Esentepe (Agios Amvrosios) take medicine to prevent malaria.
Middle East
  • The Hajj, or pilgrimage to Mecca, Saudi Arabia, is one of the world’s largest mass gatherings. In 2018, Hajj will take place from about August 19 to August 24. Travelers should prepare for hot temperatures, should stay hydrated during rituals and pack enough prescription and over-the-counter medicines to last their entire trip. Travelers should be sure they are fit to do the pilgrimage. The Saudi Ministry of Health recommends that pregnant women, older adults, children and those terminally ill postpone their plans for Hajj this year. Mass gatherings are associated with unique health risks. Before departing, travelers should visit a travel health specialist.
  • Cases of vaccine-derived polio have been reported in Syria. Most cases have been reported in Mayadeen District, in Dayr az Zawr Province. CDC recommends that all travelers to Syria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.

Pacific Islands

  • Check the World Map of Areas with Risk of Zika to find out about Pacific Islands with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Traveler Health & Safety Tips

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The CDC recommends all travelers:

  • Visit a health care provider 4 to 6 weeks before their trip for personalized health advice, vaccines, and medications.
  • Avoid bites from mosquitoes and other bugs by using an insect repellent and wearing long-sleeved shirts, long pants, closed shoes, and hats as much as possible.
  • Stay safe around animals. Do not pet, handle, or feed unfamiliar animals, even pets.
  • Be safe on international roads. Avoid overcrowded buses and cars, always wear a seat belt, and wear a helmet when riding a bike or motorcycle.
  • Wash their hands often with soap and water and use a hand sanitizer, as needed.

Current Zika Virus Recommendations

  • Check the World Map of Areas with Risk of Zika before you travel.
  • The recommendations for travelers to areas with risk of Zika are:
    • CURRENT PREGNANCY: Women who are pregnant (in any trimester) should not travel to areas with risk of Zika. Men who have traveled to an area with risk of Zika who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sexual intercourse for the duration of the pregnancy. 
    • MOSQUITO AVOIDANCE: Prevent mosquito bites while traveling to areas with Zika virus transmission, and for three weeks after returning to the U.S.
    • PLANNING PREGNANCY: If you or your partner are trying to get pregnant, consider avoiding travel to areas with a CDC Zika travel notice. Women should wait at least eight weeks after travel before trying to get pregnant. Men should either consistently and correctly use condoms during sexual intercourse or not have sexual intercourse for at least six months after travel to an area with Zika virus transmission. 
    • SYMPTOMS AFTER TRAVEL: Zika virus testing should be offered to people with symptoms of Zika virus disease, including pregnant women and others who develop symptoms during or following travel.

Resources

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